article · Frontiers in Education
Background Antifungal resistance (AFR) is a growing global health threat, particularly in low- and middle-income countries such as Zambia, where antifungals are often accessed without prescription. Antifungal stewardship (AFS) programs aim to optimise antifungal use, yet limited data exist on pharmacy students' knowledge, attitudes, and practices (KAP) toward AFR and AFS. This study evaluated pharmacy students' knowledge, attitudes, and practices (KAP) toward AFR and AFS in Zambia. Methods A descriptive cross-sectional survey was conducted among 288 randomly selected pharmacy students between August and September 2024 using a structured questionnaire. Descriptive statistics summarised demographics and KAP responses. Associations were analysed using Chi-square and Fisher's Exact Tests, while multivariable logistic regression identified predictors of good KAP ( p < 0.05). Results Among respondents (55.2% female; 76.7% aged 18–25 years), most students (94.1%) knew how to define AFR, and 90.3% recognized antifungal misuse as a factor driving resistance. Nevertheless, only 18.1% showed good knowledge, 67.7% held positive attitudes (especially among fourth-year students, p < 0.001), and merely 2.4% practiced appropriately. Multivariable analysis found that being a fourth-year student increased the likelihood of a good attitude (aOR = 5.10, 95% CI: 2.28–11.43). Married students were more likely to demonstrate good practices (aOR = 2.75, 95% CI: 1.13–6.68) towards AFR and antifungal stewardship (AFS) compared to unmarried ones. Additionally, age above 33 years was not significantly associated with better knowledge (aOR = 1.29, 95% CI: 0.32–5.18). Conclusion Pharmacy students in Zambia demonstrated positive attitudes towards AFR and AFS, but significant gaps in knowledge and practice remain. Strengthening AFR and AFS-related content and experiential training within the pharmacy curriculum is urgently needed to improve preparedness for clinical practice.
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DOI: 10.3389/feduc.2026.1846353
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